Provider Demographics
NPI:1275735383
Name:GHADIALI, MURTAZA TAHER (MD)
Entity Type:Individual
Prefix:
First Name:MURTAZA
Middle Name:TAHER
Last Name:GHADIALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10740 N GESSNER RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1240
Mailing Address - Country:US
Mailing Address - Phone:281-897-0416
Mailing Address - Fax:281-890-8908
Practice Address - Street 1:20207 CHASEWOOD PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1441
Practice Address - Country:US
Practice Address - Phone:832-237-2227
Practice Address - Fax:832-717-0111
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA98774207Y00000X
TXQ1152207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3391732-01Medicaid
TX3391732-01Medicaid
CAWA98774AMedicare PIN